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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202705
Report Date: 11/07/2024
Date Signed: 11/07/2024 12:15:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2024 and conducted by Evaluator Kiran Jain
PUBLIC
COMPLAINT CONTROL NUMBER: 26-AS-20241007092911
FACILITY NAME:CRESCENT OAKSFACILITY NUMBER:
435202705
ADMINISTRATOR:JOSHUA LAMBENGCOFACILITY TYPE:
740
ADDRESS:147 CRESCENT AVETELEPHONE:
(408) 730-4004
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:44CENSUS: 34DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Bernadette KangTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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1. Administrator is not on the premises a sufficient number of hours to meet the needs of the residents.
2. Staff are not following infection control practices.
3. Staff are not adhering to proper hand washing practices.
4. Staff do not provide resident with hand washing soap.
5. Staff do not respond to resident's request for assistance.
INVESTIGATION FINDINGS:
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On 11/07/2024 Licensing Program Analyst (LPAs) Kiran Jain and Grace Donato conducted an unannounced complaint investigation visit and met with Resident Care Coordinator Bernadette Kang. LPAs explained the purpose of the visit.

Regarding the allegation that the Administrator is not on the premises a sufficient number of hours to meet the needs of the residents, there is no contact information for the Reporting Party (RP), hence LPA was unable to get more details about this allegation.

Based on the staff (S1-S4) interviews conducted on 10/15/2024 with four staff members, , the Administrator (S4) is at the facility for 4 hours per day and in S4’s absence the Resident Care Coordinator (S3) and Med tech (S1) acts as manager on duty. Based on the resident (R1) interview conducted on 10/15/2024, R1 stated that they are satisfied with the Administrator at the facility.

Page 1 of 4... Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 26-AS-20241007092911
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: CRESCENT OAKS
FACILITY NUMBER: 435202705
VISIT DATE: 11/07/2024
NARRATIVE
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Based on the Responsible Party (RP1-RP4) interviews conducted on 11/05/2024, RP1 and RP2 stated they are happy with the response and support of the Administrator and management staff. RP3 feels communication from them could be better. RP4 sees the Resident Care Coordinator and Med Tec more often on-site.

Based on the observations during 10/15/2024 visit, Administrator (S4) and Resident Care Coordinator (S3) were present at the facility.

Regarding the allegations that the Staff are not following infection control practices, Staff are not adhering to proper hand washing practices, Staff do not provide resident with hand washing soap, Reporting Party (RP) stated that staff are not adhering to proper infection control. Staff are seen roaming the hallways with gloves on "touching resident to resident, doorknobs, cups all without washing their hands or switching gloves." Staff carry garbage bags throughout the facility and placing them outside of the residents' doors. RP also stated that staff are not providing hand washing soap for the residents to wash their hands.

Based on the staff (S1-S4) interviews conducted on 10/15/2024 with four staff members, staff wears and changes gloves after attending a resident and then wash their hands. Wash hands, put on gloves, clean them, and wash hands. Wash hands after taking care of one resident before going to another resident. Each resident room has a bathroom and common bathrooms on each floor are available for them to wash their hands. Staff receives infection control training regularly and the last one was conducted about a month ago. The staff has adequate supplies of hand washing soap, sanitizers, and gloves and they are always in fanny packs with the staff members. Based on the resident (R1) interview conducted on 10/15/2024, R1 stated the staff is always wearing gloves, always notices staff washing their hands before providing care or assistance to them and is fine with the hygiene and cleanliness of the staff, and has their soap in the bathroom. Based on the Responsible Party (RP1-RP4) interviews conducted on 11/05/2024, RP1, RP2, RP3, and RP4 are not sure if the staff follows infection control practices or not. They don’t pay attention to it. They have observed staff wearing gloves and fanny packs around their waist. RP1, RP2, RP3, and RP4 haven’t noticed if staff is following proper hand washing techniques or not. RP1 buys soap for the resident. RP2, RP3, and RP4 haven’t observed or are not aware that staff doesn’t provide residents with hand soap.

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SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20241007092911
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: CRESCENT OAKS
FACILITY NUMBER: 435202705
VISIT DATE: 11/07/2024
NARRATIVE
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Based on records review conducted on 11/05/2024, the facility places care and med tech supplies orders through an online company. Based on the review of two invoices, the supply orders were placed on 09/22/2024 through an online vendor. Based on the training records review, the facility conducts in-service training for Infection Control and hand washing exercises.

Based on observations during 10/15/2024 visit, LPAs visited resident rooms and bathrooms on the first and second floors, where caregivers and staff were observed carrying fanny packs with gloves, hand soap, and hand sanitizers around their waists. On the second floor, some of the resident bathrooms had hand soaps available. LPAs observed supplies of hand hygiene in the RCC’s office. LPAs toured the storage area in the garage where additional supplies of hand gloves, soaps, sanitizers, and paper products are stored.

Regarding the allegations that the Staff do not respond to resident's request for assistance, Reporting Party (RP) stated on one occasion, RP heard a resident yelling for help and staff just closed their door stating that, "They're okay.".

Based on the staff (S1-S4) interviews conducted on 10/15/2024 with four staff members, every 2 hours staff checks on the residents to take them to the bathroom and change. Give baths to residents that are scheduled for the day. There are call buttons in every room. Staff check the room number, go there, and ask what they need. It takes them anywhere from 30 seconds to 7 minutes to respond. Some of the staff is on standby to help residents. Based on the resident (R1) interview conducted on 10/15/2024, R1 stated that they are fine with the timeliness and attentiveness of staff when it comes to their care needs. Based on the Responsible Party (RP1-RP4) interviews conducted on 11/05/2024, RP1 feels staff is helping residents as much as they can. RP2 feels that the staff makes a good attempt at it and does pretty good overall. RP3 feels more staff and more training can be helpful. RP4 thinks the staff responds well to the resident’s assistance and feels like the facility is understaffed.

Based on records review conducted on 11/05/2024, as per caregiver’s job description and job expectation document, caregivers or supervisor on duty must respond promptly with 7-12 minutes when call light is activated. LPA confirmed this requirement with Resident Care Coordinator (S3) and was told by S3 that before they hire new staff, they set this expectation and make sure that staff understands and follow this expectation/requirement.

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SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20241007092911
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: CRESCENT OAKS
FACILITY NUMBER: 435202705
VISIT DATE: 11/07/2024
NARRATIVE
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Based on the observations during 10/15/2024 visit, LPAs observed the call light monitoring station in S3’s office. When a resident pulls a cord for assistance, it lights up on the monitoring station, S3 tells the care staff to attend the resident in the room from where the cord is pulled. The care giver attends to the resident needs and resets the pull cord. LPAs observed residents eating breakfast in the common room and a few residents who were done eating breakfast were sitting in the lobby area. Four caregivers were observed in the common room assisting the residents and 2 care staff members were observed in the lobby area.

Based on observations, interviews conducted with staff, resident, and responsible parties, and records reviewed, the department has determined that although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED.

No Deficiencies were cited under the California Code of Regulations Title 22.

This report was reviewed with Resident Care Coordinator Bernadette Kang and a copy of this report was provided.

Page 4 of 4.



END OF REPORT.
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Kiran Jain
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4